Keyhole shoulder surgery

Keyhole shoulder surgery (arthroscopy) is commonly used to treat shoulder conditions. It involves making small incisions in the skin above your shoulder and inserting an instrument called an arthroscope which contains a tiny camera. This allows the surgeon to see inside your shoulder joint in much greater detail than used to be possible with traditional open surgery.

The main benefit of arthroscopy for patients, other than the scars are much smaller, is that muscles do not to be cut or damaged to access the bones, cartilage, ligaments or tendons. This means that your recovery is faster, the infection rate from surgery is greatly reduced and the amount of blood lost during surgery is minimised.

Not all shoulder problems can be treated arthroscopically. Your surgeon will advise you. Like all surgery, arthroscopy carries some risks which are often dependent on your diagnosis, the procedure required and any underlying health conditions.

It is possible to perform a range of procedures arthroscopically to treat shoulder pain, stiffness or instability. These include:

• Shoulder stabilisation – if the shoulder fully or partially dislocates this procedure tightens the ligaments around the joint to stabilise the shoulder and prevent further dislocation.
• Rotator cuff repair – to repair damage either due to wear and tear or injury. This often needs to accompanied with a procedure for the biceps tendon, if it has become affected by the tear.
• Capsular release – if the shoulder has become tight and stiff due to frozen shoulder, mild arthritis or following an injury, the lining can be relaxed to re-create full movement.
• Acromioclavicular joint excision – the arthritic joint is widened by removing the ends of the bones, which prevents them rubbing together. You may also be advised to have this done through a small open wound if your bones are very firm or the disease is more severe.

A shoulder arthroscopy is normally carried out under general anaesthetic and usually takes an hour or less to complete. Once the anaesthetic has taken effect, small cuts will be made in the skin above your shoulder joint. The arthroscope will be inserted so the surgeon can examine the inside of your joint. Images from the camera will be displayed on a monitor. A pump is used to push cooling water through the joint. Once the damage has been identified the surgeon will repair it or remove tissue that is preventing you from moving your shoulder properly. The incision will be closed with stitches which can be removed after 10-12 days.

Shoulder arthroscopy is a day procedure so you will normally be able to go home when you are ready. You will need someone to drive you home and stay with you for 24 hours after general anaesthetic. Your shoulder may feel stiff and sore but you can apply a cold compress to reduce swelling and bruising. Depending on the procedure you may need to wear a sling for a while afterwards to protect your shoulder. Painkillers can help relieve discomfort.

You will be given exercises to do by a physiotherapist to improve strength and movement in your shoulder. Doing these regularly can help you to recover faster. You may need help with certain activities like dressing or washing immediately after surgery. It may be easier to sleep propped up to avoid putting strain on your shoulder. It can take a few weeks to recover from surgery and several months before you are completely back to normal.